Our Summary

This research examines how Canadian thoracic surgeons, those who operate on organs in the chest, are following Enhanced Recovery After Surgery (ERAS) guidelines when performing esophagectomies (removal of part of the esophagus). These guidelines are used across many surgical fields and are based on evidence that they contribute to better patient recovery. The researchers created a survey with 43 ERAS recommendations and additional questions about the surgeon’s work environment and practices.

Out of 136 surgeons in the Canadian Association of Thoracic Surgery, 74 answered the survey. Around 40% of the respondents said they have a standard ERAS protocol at their institutions, and most of them work in an academic center.

The results showed that over 80% of the surgeons followed six out of 12 ERAS guidelines before surgery, two out of eight during surgery, and seven out of 23 after surgery. Among the five guidelines with the strongest evidence of benefit, two were followed by most surgeons. Of the 29 strongly recommended guidelines, 24 were followed by most surgeons.

Overall, the study found that Canadian thoracic surgeons largely follow ERAS guidelines when performing esophagectomies. These guidelines are key to improving patient care around surgeries, but it’s crucial that they are followed closely to ensure the best outcomes for patients.

FAQs

  1. What is the purpose of the Enhanced Recovery After Surgery (ERAS) guidelines?
  2. How many Canadian thoracic surgeons responded to the survey about ERAS guidelines during esophagectomies?
  3. According to the research, how closely are Canadian thoracic surgeons following ERAS guidelines before, during, and after esophagectomies?

Doctor’s Tip

One helpful tip a doctor might tell a patient about esophagectomy is to follow all pre-operative, intra-operative, and post-operative guidelines recommended by their healthcare team. This can help improve their recovery and overall outcome after surgery.

Suitable For

Patients who are typically recommended esophagectomy include those with esophageal cancer, Barrett’s esophagus with high-grade dysplasia, and severe esophageal strictures that cannot be managed with other treatments such as dilation or stenting. Esophagectomy may also be recommended for patients with benign esophageal diseases such as refractory gastroesophageal reflux disease (GERD) or refractory achalasia. Additionally, patients with advanced esophageal motility disorders, esophageal diverticula, or other conditions that affect the function of the esophagus may also be candidates for esophagectomy.

Timeline

Before esophagectomy:

  • Patient undergoes preoperative evaluation and preparation
  • Consents for surgery and receives preoperative counseling
  • Patient may undergo imaging tests and other preoperative procedures
  • Patient follows preoperative ERAS guidelines such as fasting, bowel preparation, and smoking cessation

After esophagectomy:

  • Patient is closely monitored in the intensive care unit postoperatively
  • Patient may have a nasogastric tube, chest tube, and other monitoring devices in place
  • Patient receives pain management and is encouraged to start early mobilization
  • Patient follows postoperative ERAS guidelines such as early feeding, pain control, and prevention of complications

Overall, following esophagectomy, patients are monitored closely for recovery, complications, and long-term outcomes. The use of ERAS guidelines helps to optimize patient recovery and improve outcomes following surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about esophagectomy include:

  1. What is the reason for recommending an esophagectomy in my case?
  2. What are the potential risks and complications associated with the surgery?
  3. How many esophagectomies have you performed, and what is your experience with this procedure?
  4. What is the expected recovery time after an esophagectomy?
  5. Are there any alternative treatment options to consider?
  6. Will I need any additional treatments or therapies after the surgery?
  7. How will the surgery affect my ability to eat and swallow?
  8. What long-term effects or lifestyle changes should I expect after an esophagectomy?
  9. How will pain management be handled during and after the surgery?
  10. What follow-up care or monitoring will be necessary post-surgery?

Reference

Authors: Jogiat U, Sisson D, Sasewich H, Islam T, Low D, Darling G, Turner SR. Journal: Updates Surg. 2023 Aug;75(5):1203-1210. doi: 10.1007/s13304-023-01478-8. Epub 2023 Mar 21. PMID: 36943628